Comp6 Unit5b Lecture Slides

8/12/2019 Comp6 Unit5b Lecture Slides

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Health Management Information

Systems

Clinical Decision Support Systems

Lecture b

This material Comp6_Unit5b was developed by Duke University, funded by the Department of Health and Human Services,

Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.


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Clinical Decision Support Systems(CDSS)

Learning Objectives

1. Describe the history and evolution of clinical

decision support (Lecture a)

2. Describe the fundamental requirements ofeffective clinical decision support systems

(Lecture a)

3. Discuss how clinical practice guidelines and

evidence-based practice affect clinical decision

support systems (Lecture a)

2Health IT Workforce CurriculumVersion 3.0/Spring 2012

Health Management Information Systems


Lecture b


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Clinical Decision Support Systems(CDSS)

Learning Objectives

4. Identify the challenges and barriers to building

and using clinical decision support systems

(Lecture b)5. Discuss legal and regulatory considerations

related to the distribution of clinical decision

support systems (Lecture b)

6. Describe current initiatives that will impact the

future and effectiveness of clinical decision

support systems (Lecture b)




Lecture b


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CDSS Challenges

Achievement of the five rights of clinical decisionsupport requires communicating the

Right information

To the right person In the right format

Through the right channel

At the right time




Lecture b


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Challenges in Designing orSelecting CDSS

Whose decisions are being supported?

What information is presented?

When is the information being presented?

How is the information being presented?




Lecture b


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User Control

User presentation

Automatically

On demand

User reaction




Lecture b


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CDS Intent and Key IssuesCDS Intent Match to Users

Intention

Key Issues

Reminder of actions user

intends to do, but should

not have to remember

(automatic)

High Timing

Provide information when

user is unsure what to do(on demand)

High Speed and ease of access

Correct users errors

and/or recommend user

change plans (automatic

or on demand)

Low Automatic: timing,

autonomy and user control

over response

On demand: speed, ease

of access, autonomy and

user control over response

Table 5.1 CDS Intent and Key Issues

(Berner, 2009)




Lecture b


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Challenges in Building CDSS

Impact on Care Process and Patient Health

Outcomes

Match of CDS to user intentions User control, disruptiveness, and risk

Integration of CDS into work processes

Impact on structure Impact on resources




Lecture b


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Barriers to Using CDSS

Acquisition and validation of patient data

Modeling of medical knowledge

Elicitation of medical knowledge




Lecture b


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Barriers to Using CDSS

Representation of and reasoning about medical

knowledge

Validation of system performance Integration of decision-support tools




Lecture b


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Legal Barriers

Lack of detailed case laws for CDSS

Which category of law

Negligence law Product liability law




Lecture b


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Legal Barriers

Liability borne by

Physicians

Developers of systems




Lecture b


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Regulatory Barriers

Prerelease regulations of medical software

Data privacy and security




Lecture b


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Legislative and Regulatory Efforts

Drive measurable progress toward priority

performance goals for health care quality

improvement through effective use of CDS Explore options to establish or leverage a public-

private entity to facilitate collaboration

Accelerate CDS development and adoption

though federal government programs and

collaborations

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Health IT Workforce Curriculum

Version 3.0/Spring 2012



Lecture b


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Future Directions for CDSS

ONC initiatives

IOM studies

Meaningful use objectives and measures

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Lecture b


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ONC Initiatives

Major activities

Advancing CDS

Development of a Roadmap for NationalAction on Clinical Decision Support

AHIC CDS Work Group recommendations

Clinical Decision Support (CDS) Workshop CDS Federal Collaboratory

IOM study

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Lecture b


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IOM Studies

1999 IOM study

To improve safety, health IT systems should

be designed to make it easy to do the rightthing.

2011 IOM study

Recommend ways to make patient care safer

using health IT

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Lecture b


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Stage 1 Meaningful Use

ARRA

HITECH Programs

Regulations Meaningful use of interoperable health information

technology and qualified EHRs

Eligible Professional Hospital

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Clinical Decision Support SystemsLecture b


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Clinical Decision Support SystemsSummary

Definition

System requirements

Affects of clinical practice guidelines andevidence-based practice on CDSS

Challenges and barriers

Legal and regulatory barriers Future directions for clinical decision support

systems

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Clinical Decision Support SystemsReferences Lecture a

References

Berner, E. S. (2009, June). Clinical decision support systems: State of the Art. AHRQ Publication No. 09-0069-EF.

Rockville, Maryland: Agency for Healthcare Research and Quality

http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

AHIC. (2008, April 22). CDS recommendations, Retrieved from

http://www.hhs.gov/healthit/documents/m20080422/6.2_cds_recs.html

Centers for Medicare and Medicaid Services. (2011, November 7). EHR incentive programs overview. Retrieved

from https://www.cms.gov/ehrincentiveprograms/#BOOKMARK1

Centers for Medicare and Medicaid Services; Medicare and Medicaid Programs; Electronic Health Record

Incentive Program; Final Rule, 42 CFR Parts 412, 413, 422 et al. (July 28, 2010). Retrieved from

http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

Institute of Medicine. (2012). Health IT and patient safety: Building safer systems for better care. Washington , DC:

The National Academies Press.

Musen, M. A., Shahar, Y., & Shortliffe, E. H., (2006). Clinical decision-support systems. In Shortliffe. E. H., &

Cimino, J. J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine(3rded) (pp.

698-736). New York, NY: Springer Science + Business Media.

National Academy of Sciences. (2011, November). Report brief. Retrieved from

http://iom.edu/~/media/Files/Report%20Files/2011/Health-IT/HealthITandPatientSafetyreportbrieffinal_new.pdf

National Academy of Sciences. (2000). Report brief. Retrieved from

http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-

Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

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http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.htmlhttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html


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Clinical Decision Support SystemsReferences Lecture a

References

Office of the National Coordinator for Health Information Technology. (2011). CDS activities. Retrieved from

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__cds_activities/3787

Osheroff, J. A., Teich, J. M., Middleton, B. F., Steen, E. B., Wright, A., & Detmer, D. E. (2006, June 13).A roadmap

for national action on clinical decision support (ONC Contract HHSP233200500877P). Retrieved from AMIA

website: http://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-

June132006.pdf

Sirajuddin, A. M., Osheroff, J. A., Sittig, D. F., Chuo, J., Velasco, F. & Collins, D. A. (2009, Fall). Implementation

pearls from a new guidebook on improving medication use and outcomes with clinical decision support. Journal of

Healthcare Information Management. 23(4), 38-45.

U.S. Department of Health and Human Services. (2010, September 29). Institute of Medicine will study best

policies and practices for improving health care safety with health information technology. Retrieved from

http://www.hhs.gov/news/press/2010pres/09/20100929b.html

Table5.1 Table: Berner, E. S. (2009, June). Clinical decision support systems: State of the Art. AHRQ Publication No. 09-

0069-EF. Rockville, Maryland: Agency for Healthcare Research and Quality

http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

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http://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.hhs.gov/news/press/2010pres/09/20100929b.htmlhttp://www.hhs.gov/news/press/2010pres/09/20100929b.htmlhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdfhttp://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-June132006.pdf

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